Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
Authors: Massimiliano Greco, Thomas De Corte, Ari Ercole, Massimo Antonelli, Elie Azoulay, Giuseppe Citerio, Andy Conway Morris, Gennaro De Pascale, Frantisek Duska, Paul Elbers, Sharon Einav, Lui Forni, Laura Galarza, Armand R. J. Girbes, Giacomo Grasselli, Vitaly Gusarov, Alasdair Jubb, Jozef Kesecioglu, Andrea Lavinio, Maria Cruz Martin Delgado, Johannes Mellinghoff, Sheila Nainan Myatra, Marlies Ostermann, Mariangela Pellegrini, Pedro Povoa, Stefan J. Schaller, Jean-Louis Teboul, Adrian Wong, Jan J. De Waele, Maurizio Cecconi, Marco Bezzi, Alicia Gira, Philipp Eller, Tarikul Hamid, Injamam Ull Haque, Wim De Buyser, Antonella Cudia, Daniel De Backer, Pierre Foulon, Vincent Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste Mesland, Patrick Biston, Michael Piagnerelli, Lionel Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe Vanhove, Pierre Bulpa, Viktoria Ilieva, David Katz, Alexandra Binnie, Anna Geagea, Fernando Tirapegui, Gustavo Lago, Jerónimo Graf, Rodrigo Perez-Araos, Patricio Vargas, Felipe Martinez, Eduardo Labarca, Daniel Molano Franco, Daniela Parra-Tanoux, Luis Felipe Reyes, David Yepes, Filip Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal Abdelnasser, Ahmed Hammouda, Omar Elmandouh, Ahmed Azzam, Aliae Mohamed Hussein, Islam Galal, Ahmed K. Awad, Mohammed A. Azab, Maged Abdalla, Hebatallah Assal, Mostafa Alfishawy, Sherief Ghozy, Samar Tharwat, Abdullah Eldaly, Anneli Ellervee, Veronika Reinhard, Anne Chrisment, Chrystelle Poyat, Julio Badie, Fernando Berdaguer Ferrari, Björn Weiss, Clara Schellenberg, Julius J. Grunow, Marco Lorenz, Stefan J. Schaller, Peter Spieth, Marc Bota, Falk Fichtner, Kristina Fuest, Tobias Lahmer, Johannes Herrmann, Patrick Meybohm, Nikolaos Markou, Georgia Vasileiadou, Evangelia Chrysanthopoulou, Panagiotis Papamichalis, Ioanna Soultati, Sameer Jog, Kushal Kalvit, Sheila Nainan Myatra, Ivan Krupa, Aisa Tharwat, Alistair Nichol, Aine McCarthy, Ata Mahmoodpoor, Tommaso Tonetti, Paolo Isoni, Savino Spadaro, Carlo Alberto Volta, Lucia Mirabella, Alberto Noto, Gaetano Florio, Amedeo Guzzardella, Chiara Paleari, Federica Baccanelli, Marzia Savi, Massimo Antonelli, Gennaro De Pascale, San Luca, Barbara Vaccarini, Giorgia Montrucchio, Gabriele Sales, Katia Donadello, Leonardo Gottin, Marta Nizzero, Enrico Polati, Silvia De Rosa, Demet Sulemanji, Abdurraouf Abusalama, Muhammed Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy Canedo, Alejandro Esquivel Chavez, Tarek Dendane, Bart Grady, Ben de Jong, Eveline van der Heiden, Patrick Thoral, Bas van den Bogaard, Peter E. Spronk, Sefanja Achterberg, Melanie Groeneveld, Ralph K. L. So, Calvin de Wijs, Harm Scholten, Albertus Beishuizen, Alexander D. Cornet, Auke C. Reidinga, Hetty Kranen, Roos Mensink, Spaarne Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver Beck, Carina Bethlehem, Bas van Bussel, Tim Frenzel, Celestine de Jong, Rob Wilting, Jozef Kesecioglu, Jannet Mehagnoul-Schipper, Datonye Alasia, Ashok Kumar, Ahad Qayyum, Muhammad Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia Taborda, Mónica Anselmo, Tiago Ramires, Catarina Silva, Carolina Roriz, Rui Morais, Pedro Póvoa, Patricia Patricio, André Pinto, Maria Lurdes Santos, Vasco Costa, Pedro Cunha, Celina Gonçalves, Sandra Nunes, João Camões, Diana Adrião, Ana Oliveira, Ali Omrani, Muna Al Maslamani, Abdurrahmaan Suei elbuzidi, Bara Mahmoud Al qudah, Abdel Rauof Akkari, Mohamed Alkhatteb, Anas Baiou, Ahmed Husain, Mohamed Alwraidat, Ibrahim Abdulsalam Saif, Dana Bakdach, Amna Ahmed, Mohamed Aleef, Awadh Bintaher, Cristina Petrisor, Evgeniy Popov, Ksenia Popova, Mariia Dementienko, Boris Teplykh, Alexey Pyregov, Liubov Davydova, Belskii Vladislav, Elena Neporada, Ivan Zverev, Svetlana Meshchaninova, Dmitry Sokolov, Elena Gavrilova, Irina Shlyk, Igor Poliakov, Marina Vlasova, Ohoud Aljuhani, Amina Alkhalaf, Felwa Bin Humaid, Yaseen Arabi, Ahmed Kuhail, Omar Elrabi, Madihah E. Ghannam, Ng Teng Fong, Amit Kansal, Vui Kian Ho, Jensen Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª del Pilar García-Bonillo, Antonio Padilla-Serrano, Marta Martin Cuadrado, Carlos Ferrando, Ignacio Catalan-Monzon, Laura Galarza, Fernando Frutos-Vivar, Jorge Jimenez, Carmen Rodríguez-Solis, Enric Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria Ioan, Cesar Perez-Calvo, Arnoldo Santos, Ane Abad-Motos, Javier Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, José M. Bonell-Goytisolo, Iñigo Salaverria, Antonia Socias Mir, Emilio Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo Concha, José Angel Berezo-Garcia, Virginia Fraile, Cristina Cuenca-Rubio, David Pérez-Torres, Ainhoa Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire Larrañaga, Noemi Legaristi, Gerardo Ferrigno, Safa Khlafalla, Rosita Bihariesingh-Sanchit, Hallands Sjukhus, Frank Zoerner, Jonathan Grip, Kristina Kilsand, Johan Mårtensson, Jonas Österlind, Akademiska Sjukhuset, Magnus von Seth, Västerviks Sjukhus, Johan Berkius, Samuele Ceruti, Andrea Glotta, Seval Izdes, Işıl Özkoçak Turan, Ahmet Cosar, Burcin Halacli, Necla Dereli, Mehmet Yilmaz, Türkay Akbas, Gülseren Elay, Selin Eyüpoğlu, Yelíz Bílír, Kemal Tolga Saraçoğlu, Ebru Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe Mengi, Kezban Ozmen Suner, Yakup Tomak, Ahmet Eroglu, Asad Alsabbah, Katie Hanlon, Kevin Gervin, Sean McMahon, Samantha Hagan, Caroline V. Higenbottam, Randeep Mullhi, Lottie Poulton, Tomasz Torlinski, Allen Gareth, Nick Truman, Gopal Vijayakumar, Chris Hall, Alasdair Jubb, Lenka Cagova, Nicola Jones, Sam Graham, Nicole Robin, Amanda Cowton, Adrian Donnelly, Natalia Singatullina, Melanie Kent, Carole Boulanger, Zoë Campbell, Elizabeth Potter, Natalie Duric, Tamas Szakmany, Royal Brompton, Orinta Kviatkovske, Nandor Marczin, Caroline Ellis, Rajnish Saha, Chunda Sri-Chandana, John Allan, Lana Mumelj, Harish Venkatesh, Vera Nina Gotz, Anthony Cochrane, Barbara Ficial, Shruthi Kamble, Nuttha Lumlertgul, Christopher Oddy, Susan Jain, Giulia Beatrice Crapelli, Aikaterini Vlachou, David Golden, Sweyn Garrioch, Jeremy Henning, Gupta Loveleena, Miriam Davey, Lina Grauslyte, Erika Salciute-Simene, Martin Cook, Danny Barling, Phil Broadhurst, Sarah Purvis, Michael Spivey, Benjamin Shuker, Irina Grecu, Daniel Harding, Natalia Singatullina, James T. Dean, Nathan D. Nielsen, Sama Al-Bayati, Mohammed Al-Sadawi, Mariane Charron, Peter Stubenrauch, Jairo Santanilla, Catherine Wentowski, Dorothea Rosenberger, Polikseni Eksarko, Randeep Jawa
Journal: Intensive Care Medicine (2022)

To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients.Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020.4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors.ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.